Cancer Research UK

Improving early detection of bowel cancer – a social marketing pilot in partnership with NHS Derby City

Daniel Ramsay

Marketing Manager

Cancer Research UK

Why did we do this?

1. Trial a social marketing approach

2. Learn more about types of materials and messages that can be effective in early detection of Bowel Cancer

3. Develop greater understanding of how to evaluate impact

4. Provide well evaluated results for wider dissemination

5. Work closely with Derby PCT

Background and Objectives

CRUK partnered with Derby City PCT to run a social marketing pilot in a

number of deprived wards in Derby City, focusing on early detection of bowel cancer – the third most common cancer in the UK.

Objectives:

• to increase bowel cancer symptom awareness in Derby amongst 50+ age

group, and promote the importance of early detection

• to encourage early presentation of symptoms to a GP

• to actively engage with local residents (men aged 50+) and healthcare

professionals (in particular GPs)

• to inform the understanding of CRUK, Derby City PCT and other bowel

cancer stakeholders

• to develop a campaign framework that could be used as a future model

Our approach

9 key steps designed to:

•ensure action is rooted in insight

•enable co-creation with stakeholders and target audience

•make the most of existing insight and achieve maximum

value from the budget available

•deliver targeted local activity that resonates with the

target audience

•provide solid foundations for replication

Our approach9 key steps

context

audience

motivation

propositions

co-creation

conceptualisation

implementation

testing

evaluation

Key wards

Identifying the audience

• Used hospital admissions data in order to identify those most ‘at risk’

• individual occasions recorded across 2007/2009

• Focused on wards identified by Derby PCT

Sinfin, Alvaston, Boulton, Derwent, Mackworth, Darley and

Chaddesden

Considered:

1. admission volumes by ward

2. admission volumes by MOSAIC type – across Derby

3. admission volumes by MOSAIC type – in the key wards

4. top MOSAIC types across both the key wards and the total Derby population

5. recommended target groups for this project

6. focusing on those types with an older profile

Final pen portrait – 50+ menwatching sport on TV is a favourite pastime “I like spending most of my

leisure time at home”

49% are overweight but are generally trying to be healthy

Source: NHS Derby Admissions/Mosaic

“there’s little I can do to change

my life”

highly traditional – “real men don’t cry”

“ I don’t like to

show my own

feelings”

“I think health

foods are only

bought by fanatics”

Gaining insight1. Learning from others

• Merseyside and Cheshire Cancer Network – awareness and early detection of bowel cancer (50+ males)

• Sandwell PCT – uptake of bowel cancer screening (60+ males)

• Improvement Foundation / DH – promoting earlier presentation of cancer symptoms (bowel, breast, lung)

• DH Prostate Cancer Advisory Group – prostate awareness qualitative research

• Doncaster PCT – Early Lung Cancer Intervention

• Prevent Cancer Foundation – Dialogue for Action in Colorectal Cancer Screening

• Men’s Health Forum – Bowel Cancer Screening

2. Identifying key motivators/barriers to behaviour

• Peace of mind, survival rates etc.

3. Testing visual themes with focus groups of target audience

• Male, 50+, C2DE

Key motivatorssurvival rates, positive facts

It’s ok to go

and see the

doctor – this

is important

peace of mind

It’s ok to talk

about it –

everyone is in

the same boat

the earlier you

go, the less of

a big deal it is

Themes

Creative development• Conclusions from focus groups:

• key message should address seriousness of disease e.g. 1 in 16

men develop bowel cancer

• supporting messages should encourage presentation to GP by

providing clarity around symptoms, and positive survival stats

• tone should be direct, fact-based, and possibly humorous (groups

reacted positively to ‘tongue in cheek’ feel of Cancer Chancer)

• execution should use memorable imagery that resonates with

audience (groups identified with image of Bobby Moore as a ‘real’

person)

• 4 concepts were tested as part of pre-wave quant research (3

new concepts, plus Cancer Chancer)

• Bobby Moore concept proved strongest

Concepts for testing

Bobby Moore image by Getty Images

• Communicates bowel cancer as a serious

disease

• Likelihood of self-check

• Communicates ‘important to check for blood in

your stools’

• Communicates ‘important to see doctor if

change in toilet habits’ well

Testingg

Implementation – three core elements

High impact awareness raisinghigh impact outdoor media, PR launch and media relations

Grass roots engagement to create a conviction of the need to actface to face engagement in key locations across the target wards

Distribution of retainable information to facilitate behaviour changetapping into existing networks and groups

GP/Oncologist engagement

Campaign ran for one month in February 2010 in 7 key

wards identified at outset

• initial contact via GP Cancer Lead

• follow up call to Practice Manager

1. GP briefing

2. support campaign in surgery

3. data provision

GP engagement

PR

• Local case study in Derby Evening

Telegraph

• 2 x Radio interviews – Dr Jodie

Moffat, and Dr Andrew Goddard

(Consultant GI) on BBC Radio Derby

• Derby City FC – hit squads and advan

present on match day, and news story

on www.dcfc.co.uk

Challenges:

• Locally relevant stats

• Support from local media

Media

strategy:

• generate awareness, support grass roots activity

• geographic targeting – ward level

• men over 50 lower socioeconomic groups

options:

• 6 sheets in targeted locations, e.g. Bookies, pubs

• advans

• bus routes

• healthcare settings – GP surgeries

challenges:

• Not all wards had 6 sheet sites

• Combining behavioural and geographical targeting

• Staying within the 7 wards – press

media selection:

• 6 sheets – 30 sites within wards

• Advans – 2 x 4 weeks, Fri and Sat, coincide with comedy nights

• Press – 1 Wrap, full page ad, strips

Media

coverage:

outdoor: 60% @ 12 OTS against our 50

plus men in derby (excluding advan as this format is not possible to calculate)

www.spotcancerearly.com/bowel

Grass roots engagement

• two elements to grass roots engagement

• hit squad activity to distribute materials and engage target public in key

locations

• a series of events to generate peer-to-peer conversation and ensure

quality interaction

• event options considered included:

• comedy events

• barber-shop road show

• race night

• although some debate around alignment with Bobby Moore theme,

comedy events were selected as best fit for campaign philosophy and

audience

Hit squad activity

• distribution of materials and face

to face engagement of target

public across the 7 wards, in:

- pubs

- social clubs

- DIY stores

- barbers

- local shops

- Derby County FC

• beer mats and posters to raise

awareness

• z-cards for people to take away,

retain and share

Hit squad activity

good

• locations worked really well – lots of target audience

• Derby County FC was a great venue

• venue staff were all very supportive

• shops take z-cards at the cash desk

• whoopee cushions were great

• creative was high impact – people approached of their own accord and it led to good quality conversation

• z-cards were great for those less willing to engage

• pubs and bars achieved great interaction

• hit squad were able to easily engage men

challenges and opportunities

• confusion about testing (50 to 60?)

• feedback on creative not being ‘tactful’ enough

• conversations were sometimes challenging

• many women wanted to talk to us also and asked why the campaign was only aimed at men

recommendation: support hit squad activity with the presence of a health

care professional and / or an authoritative voice from CRUK

recommendation: ensure you have info / stats for women and also use them

to distribute information to husbands, fathers etc

Comedy events

• 7 stand-up comedy performances by Northern comedian Greg Cook in:

- Chaddesden Lace Club (30)

- Rolls Royce Social Club (200)

- Royal British Legion Darley Abbey (35)

- Royal British Legion Allenton & District (70)

- Chaddesden Park Social Club (120)

- Alvaston & Crewton Men’s Social Club (100)

• support of hit squads to recruit audience,

set-up room and engage men in conversation

• branded pull-up banners

• branded whoopee cushion giveaways

• pre-event promotion posters, empty-belly for clubs to complete

Comedy events

good

• comedy went down a storm – people

were shouting for more

• using a regional comedian was vital

• ready-made crowds

• content was pitched perfectly

• generally crowd sizes were good and lots of target audience

• locations did vary but comedian was great at tailoring his act

• venues were very supportive and bent over backwards to help us

• crowd competition was introduced and increased engagement / participation

challenges and opportunities

• Sinfin Moor Social Club was closed and Rolls Royce Social club had low turnout, and had to be rescheduled

• other activities are often being run

• many wanted to fundraise

• decisions are made by ‘committee’

• pull-ups conflicted with tone of comedy

recommendation: schedule around 6 months in advance and increase publicity

recommendation: if resource allows, reccy venues and engage face to face so you understand size, crowd type etc.

recommendation: piggy back where possible

recommendation: place pull-up banners away from stage

Community engagement

campaign resources and briefing document sent to:

• neighbourhood forums in all 7 wards (part of Derby Community Safety

Partnership)

• GP surgeries

• pharmacies

• libraries – drop in event held at Derby City Library with local health

promotion nurse

• sports clubs e.g. Derbyshire County Cricket Ground

• Derby over 50s forum

• Derby LINk – local involvement network

Evaluation• Audience research

• 300 pre and post face to face surveys (600 in total)

• surveys based on Bowel CAM – adjusted to capture awareness of

campaign, as well as symptom knowledge, and intent to visit GP

• GP Consultations

• 3 months prior, during, and 3 months post

• Comparing to same period 2009

• Rectal bleeding (painful and painless)

• Change of bowel habit

• Abdominal mass

• Referrals

• 3 months prior, during, and 3 months post

• Same period 2009

• Screening Uptake

Results – Audience ResearchPre wave Post wave

Impact

Recall of bowel cancer communications

Recall of campaign branding

26% spontaneous (28%)

16% spontaneous (11%)

42% spontaneous (25%)

27% spontaneous (12%)

Communication

Warning signs – blood/bleeding

Warning signs – blood in stools

Bleeding from back passage

Change in bowel movements

Main message – symptom awareness

47% spontaneous (44%)

17 % spontaneous (15%)

9% spontaneous (9%)

5% spontaneous (4%)

6% spontaneous (3%)

65% spontaneous (40%)

33% spontaneous (14%)

21% spontaneous (10%)

13% spontaneous (5%)

26% spontaneous (0%)

Personal concern 18% very concerned (21%) 25% very concerned (16%)

Age association 14% very common among

50+ men (21%)

25% very common among

50+ men (19%)

Importance of early diagnosis 73% rate extremely

important (76%)

82% rate extremely

important (71%)

Confidence noticing symptoms 32% very confident (23%) 46% very confident (27%)

GP consultation data

5 surgeries, from 5 different wards, provided data on bowel

cancer symptom consultations (out of 8 initially contacted):

• during campaign – 4 consultations

• same period in 2009 – 5 consultations

• 3 months prior to campaign – 21 consultations

• 3 months after campaign – 14 consultations* * only based on 4 surgeries

small quantities – difficult to review shifts in gender, age etc

• possible from a wider pool of data e.g. 6 months pre and

post campaign period, as opposed to 3**

Referral data (2 WWR)

• breakdown of age and gender of referrals for GP practises in 7 wards

during campaign period (and in 2009):

• apparent shift in gender and male age (age shift is a mean as opposed

to median so we can’t rule out the possibility that a small number of

additional young referrals have biased the results)

• appears as though campaign has had an impact. But, no lasting shifts

.

2009 2010

Female age 66.2 (44-88) 68.0 (54-83)

Male age 78.1 (55-90) 56.6 (40-64)

Male/female 6:8 8:7

Accessing screening data currently

Summary• overall good results given weight of media

• campaign elevated perceptions of seriousness and

raised concern about the disease

• increased awareness of core symptoms translated into

greater confidence and likelihood to visit GP

• secondary care data illustrates an increase in appropriate referrals in target wards during campaign,

but no lasting impact

• activity could have impacted on GPs (more likely to

refer appropriately) and on patients (more confident to seek referral) but no impact on consultations

Questions?